If you live in the state of Washington - RUN for the hills!

[Pharmacist.steve]

http://www.drugtopics.com/drugtopics/article/articleDetail.jsp?id=394818&searchString=washington%20state

In the guidelines, the Interagency Workgroup panel recommends a total maximum daily dose of 120 mg of morphine or its equivalent. If a prescriber feels higher doses are needed, the workgroup recommends getting a second opinion from a physician specializing in pain management.

[Jo6]

interesting. I'm not surprised though. In my state many things have been going on, just not sure what. DEA is not hiding that's for sure.

I would love not taking any pain meds., but in order to get about it is a must. I fought it for a very long time, but the max dose of tylonal everyday of my life wasn't good either.

Julia

[Cry Tears]

Too bad its cold and raining ALL the time here in the Pac NW. The hills around here are snowbound! Not conducive to tropical plant fauna!
I'm sure home grown natural remedies would be more prevalent than it is.

OK...so the guidlines are such.
What if you have multi complex pain sources?

I have Crohns (2 small bowel resections, they took 3 feet total, scar tissue, pain, a small obstruction needing repaired..but more scar tissue may cause worse...sigh...)

Peripheral Neuropathy, (EMG and NC showed moderate sock glove pattern)
It got better by taking Methyl B12...but now has spread over my entire body, perhaps as my body repairs? Hope its that!

Post Cholysectomy (SP?!) syndrome (Pain 24/7 after gall bladder surgery...feels like a knife in my side ALL the time!) Good feeling!

Fibromyalgia....causing muscle and joint pain.

Inflamitory arthritis "process"....(more of the joint and muscle pain.)

Baseball sized Arterioveinous Malformation (anuerism like) in my small intestines that bled for 2+ years, severe anemia, Hmg 5.1 was the lowest, 8.5 was the highest during this time. Hematacrit was 17%:eek: Talk about Onoxia!

Back pain from 4 car accidents...head on '95, side roll on ice '99, T-boned '74, roll over (4 rolls) '69...but the back pain takes a back burner as I'm just not interested in investigating this further.

5 infertility surgeries that has left my lower abdomon in slight pain, lots of scar tissue built up, finally a complete historectomy when I was 35 because of Endometirosis.

Sjogrens...cold hands, feet, nose, heart!

A few issues such as being kidnapped, drugged and raped by a 45 yo man when I was 14.
During my anemia "bout" I was a victim of ID theft....huge case in our area, making it headline news. She even purchased a car using my stolen credit cards...Police refused to let me report as stolen:eek: AND I had to insure it!
She spent $125,000 in 2 weeks! Crime DOES pay! At her "trial"...ha! big joke, it was her 13th felony conviction....yes...you read that righ, 13th Felony CONVICTION! for writting stolen checks and ID theft.
The judge only gave her probation! Now isn't he nice!?!?!
She's got all my mail for several weeks, gleaning mail that interested her, such as my pain clinic billing/info....tax stuff...this was mid Jan when she began "my" ID theft. So....forced to be alone for test, transfusions and numerous appointmets trying to find the source of my bleed...we couldn't leave our home unsecured...someone had to be here 24/7...she'd come up our long driveway several times with her convict boyfreind several times. So...I let her yap during her sentencing....yada, yada....poor me! BS!
Point it...I was devastated by what was done to me when I was so ill.

My husband also suffers from having mouth/tongue cancer return.
Sometimes life just isn't fair is it!?!?!

Oh...and a hang nail on my index finger!

So does this mean I'll be given 120mg for each pain issue?
While at the same time...being silly about this...i try to find something to laugh about...else I'll cry. But does this qualify me for more/higher dosing?
Where do you draw the line?
How much is too much when your body becomes "resistant" to opiod "therapy"?
What is my pain going to be like in 20 years when I am older?
What guidlines will they have in place then if more doctors like Dr Feillin puts more loose ended studies in national news media....credentialed and beleivable, respected....are more physcians going to withdraw our "life source" because the live giving meds are addicting"
Somethings got to change and we need pain managment doctors advocate for those who are suffering needlessly.
Those who live in Washington....come on down! Just shake the snow off yer boots!
Seriously....are there PM advocates going to "bat" for those who need it?
Or are those who suffer pain going to be forced into playing the games such as 12 step programs and have dr's who beleive the crap written like this, tring to discourage using something that works ! ? ! ?

And the articals I've read lately...such as if we only educate ourselves, come to grip with our pain...yada, yada, yada! Someone has their head stuck in a bucket of peanut butter...lets just hope they dont pull out!
This really angers me!
signed....X
I wonder if some DEA beancounter is getting a raise for collecting names of those who post in a pain forums! scarey thoughts! But think about this!
How "safe" is this to practice freedom of speach and sharing when it comes to PM, opiods and drugs!

[Cry Tears]

One more thought....What about dosing the same dose, for same pain to different bodies?
Example: Former foot ball quaterback, Fredrick, a 23 year old male, @ 6'3", 285 lbs is prescribed: 60mg Oxycontin 3 times a day plus 15 mg of Norco 3 X day for BT pain.

While Freida, very slight build, 72 years old, @ 4'8", 94 lbs gets same dose as Fredrick.
To me it just doesn't make sense! Or does it?

[Pharmacist.steve]

CRYTEARS

Come-on .. don't hold back .. tell us what you REALLY THINK!!!:rolleyes:

[Mark N]

Let me see, if their were 10 deaths the previous year and 14 this past year {40% increase] we should panic and change the system for people that are in incredible pain. Now I have no idea what the number of deaths are but it could be just 14 since they don't bother to tell us the number, my guess is they would be embarassed by the number of deaths so they use a % that sounds higher.

This is another example to the maternal gov't so many want. We want the gov't to do everything to protect us and make sure we don't get hurt. Be careful what you wish for because we are starting to reap the rewards of letting the gov't take care of so many in our population. There are people that need help but when it gets to the point that we can't make decisions for ourselves it needs to stop. Our pain treatment is being attacked but it isn't isolated. We need to understand that many other things tie into this problem and we better rethink how much we want our gove't to be in our lives.

[lobelsteve]

http://www.drugtopics.com/drugtopics/article/articleDetail.jsp?id=394818&searchString=washington%20state

In the guidelines, the Interagency Workgroup panel recommends a total maximum daily dose of 120 mg of morphine or its equivalent. If a prescriber feels higher doses are needed, the workgroup recommends getting a second opinion from a physician specializing in pain management.

As long as they are saying the limit is for non pain specialized physicians- I would agree. THe difference is in the physicians ability to manage the pain while reducing the public risk of abuse/diversion. There is no education for the PCP on Pain Medicine.

The issue will be- access to care. What if no specialist is around? THere needs to be clear guidelines on this to prevent limits on access to care.

I see no problem if that end of it can be resolved. The same reason you would not want me taking out your gallbladder- I'm not trained to do so.

[Mark N]

Steve, there are some PCPs that do know about pain management and fortunately my PCP not only knows PM but also knows what our pain is like as he has severe MS. He openly says that his pain is not as severe as mine is or as severe as others. His sister is a chronic pain patient and he knows what we go through on a daily basis. I have had two PCPs that know what the PM is from their training but you are right that most PCP don't have the background for PM. I went to a PM clinic and they diminished my spine problems and my pain in spite of all the muscle spasms that couldn't be released and wanted to use spinal manipulation on spinal fusion patients. There was no way I was going to let them do that to me and the psych.doctor didn't diminish the amount of pain I had [no opiates at that time or for another 3 years] and offered stronger meds but I turned them down and she told me that I handled my pain very well.

The people that make the laws and restrictions about our meds don't know what our pain is like but think they know what is best for us. Too many people don't know what it is like to walk in our shoes but they think they can judge what every one of our days is like. There are only a few doctors like you that know what some of us go through.

[illusion129]

Taken from: http://www.drugtopics.com/drugtopics/article/articleDetail.jsp?id=394818&searchString=washington%20state

Controlled-release oxycodone, at 8 mg twice daily, is not an uncommon dose; it would be equivalent to 120 mg of morphine, he said, leaving no room for an opioid prescription for breakthrough pain.

I'm assuming that the pharmacist who wrote this article intended to type "...at 80 mg twice daily..." instead of only 8mg.

From looking at a few equalanalgesic dosing charts, it says that Oxycodone is 1.5-2 times more powerful than Morphine, so how does this pharmacist come up with 160mg of Oxycodone equaling 120mg of Morphine if Oxycodone is in fact more powerful?

[krashleen]

Hmm, without giving out too much information..I will comment on this. My PM doc is in WA state, and he has discontinued seeing patients that are on L&I, and this is where this decision is coming from.
This does NOT impact those that are not on the State Labor and Industries (Workers Compensation) so not all need to run for the hills.

Unfortunately, the state got involved, and compassionate docs did get squeezed. Its a sad state of affairs for those on WC.

[Pharmacist.steve]

Hmm, without giving out too much information..I will comment on this. My PM doc is in WA state, and he has discontinued seeing patients that are on L&I, and this is where this decision is coming from.
This does NOT impact those that are not on the State Labor and Industries (Workers Compensation) so not all need to run for the hills.

Unfortunately, the state got involved, and compassionate docs did get squeezed. Its a sad state of affairs for those on WC.

The downside of this is ... this could become the "standard of care" in the state of Washington... once a major player implements something .. the rest of the players (Medicaid/insurance) will try to get into "lock-step". Since there are a limited number of pain docs... this could end up a rationing of care..

[BrokenBladder]

I'm on disability and I didn't take the Part D of medicare. The reason is that I didn't want the government to, at some point in the future, tell me what kind of medication I could be on. Maybe I'm being paranoid, but then again, maybe not.

[Pharmacist.steve]

Maybe I'm being paranoid, but then again, maybe not.

Whether you are paranoid or not.. it is a fact that whatever Medicaid/Medicare does the rest of the insurance industry emulates. From the Pharmacy side of medical care .. the government pays for -directly or indirectly - over 50% of all Rxs filled at retail.

Right now there is a pilot program in Michigan - under written by Ford-GM-Chrysler where a computer system tell the doc what meds are to be prescribed given the diagnosis.. Initial findings is that they have been able to reduce Rx expenditures by $10/Rx - about 20% overall.

Medicare part D has already initiated a rather crude version of this .. it is called step therapy.. when a patient is diagnosed with a certain condition you get to try the cheapest drug available for the condition .. if that fails .. you get to move up the step therapy ladder to the next higher cost drug.. It is just a matter of time... before the whole industry insurance industry does this.

[Joey54]

Kneejerk ..........................................

[mickeysblog]

Okay, I moved here from Colorado. I have found a doctor who is a PM doctor. The "family" doctor that I had was a nut case. He never once examined me. Simply sat down and said "what scripts do you need"? I do see the need for control, but the control is within us. We are the ones with pain, pain that lasts all night, all day. It does no good to simply use meds to control it. There is no control that truly works. I have tried and tried to find answers for the pain that I have. Every time that I feel someone really listens to me, hears me. Wants to find the cause of my pain, bang,,,we go off on ten different directions. In Colorado I had an amazing doctor who cared. Here in Washington I finally have found one as well. But its a long road ahead I fear. My pain changes. If I try to deal with my back pain from three discs that are out, my legs ache, my ankles ache, they find lesions in my brain suggestive of MS. SO off we go onto another journey. I don't believe that I have MS. If I do why is it so painful. From all I have read it does not create the endless cramping and pain that I have all night, all day. I do have a lot of issues that might be MS, but no numbness. I wish at times I had numbness. Once we did a steroid release. It worked so well that I became afraid to go back to the dark pain hole that I new would come in time. It is here once again and I don't no any more what to do. I have a Neurologist who is seeing me for the MS. A pain specialist that is seeing me for pain but has the doctor who is the script writer non touching no discussing doctor write my scripts. I feel lost and I wish I would have stayed in Colorado. But there they only wanted to experiment on my back with artificial disc being placed into an area where the two discs above were shot. Now I have the same type of pain starting in my neck. The MRI says that it is narrowing. The neuro wants me to get off all pain meds, or at least drop them down. I don't take that much. A pain patch that is changed every three days. When I have the exacerbations I use a Loratab to help. Muscle relaxers, Oxi and other meds caused my stomach to bleed so I must be careful at all times thus the patch.
Lost, feeling hopeless in Washington. What the **** is wrong with me? How can I have pain in my muscles, neck, legs, hands, arm, shoulder. Never swelling in my joints, no redness. How can this be MS? Where do I go from here? How do you find one Physician who really can get to the bottom of this?
Washington is where I want to stay. But I cant live without help if I can find it. Pain meds are a part of my life and I will not live without them. This is not living anyway, its just screaming inside. What could cause your muscles to burn, ache as if they are ripping away from the bone. headaches, pain in my back, neck lower back from three or more by now discs blown can be most of my leg and back issues, but not the rest. IS MS painful, my Neuro says no. Why do I have cramping in my feet, unable to walk from the pain in the bottom of my feet. It hits and it hits hard. How do you find a doctor who is part ortho, neuro, pain management, arthritic, MS specialist? Cant have ten doctors all trying to go in different directions. I feel as if I will die soon if I dont find answers. The pain is going to kill me if nothing else
Any advice is so needed. .
Mick

[Kira]

How do you find a doctor who is part ortho, neuro, pain management, arthritic, MS specialist? Cant have ten doctors all trying to go in different directions.

That is is the million dollar question.

Right now I have twelve, plus therapists: Internal Medicine, Metabolic/Biochemical Genetics, Metabolic/Neuro, Neuromuscular, PM&R/Pain Management, Orthopedic Surgeon, Nephrology, Cardiology, Psychiatry, Ophthalmology, ENT, Allergy/Immunology. Also a Physical Therapist, a Pool Physical Therapist, a Metabolic Nutritionist, a Therapist (Psych), and a Genetic Counselor. It took me a long time to get a team of doctors I like and trust who are smart.

Sometimes you do need the input of multiple different kinds of specialists. In that case, it is most important to have a one doc who coordinates everything and helps put all of the pieces together. For me, that is my metabolic docs (mostly) and my primary care doc (to a lesser extent).

Also, I am a little concerned about your primary care doc, if he/she doesn't even examine you and just writes scripts. Can you find a new one?

It took me a long time to get my issues figured out, and it took four years to get to the point where the docs even believed me that something was wrong. I have only got a partial diagnosis, even now.... we know I have a hereditary metabolic disorder but are trying to get the specific enzyme defect pinned down. Being in limbo sucks and I really feel for you.

One thing I learned along the way is to be careful of docs who assume that nothing is wrong once they rule out the one or two things that they thought of first. Back when I started having symptoms 6 years ago, they did a small neuro work-up. They were wondering about MS and Lyme (recent tick bite in an endemic area). I had an MRI, a spinal tap, bloodwork for Lyme, and some basic labs. It all came back normal, which of course it would, since neither of those diseases is what I have. But then they decided that, since it wasn't MS or Lyme, it wasn't anything. They told me it was all in my head. In reality, though, it was just something they hadn't tested for. So, have faith in yourself and keep that in mind.

Another very important thing that I learned was that, even with a real physical illness, there is a big mental piece, especially when you don't know what is wrong with you. You end up trying to notice every little thing going on in your body because it might be a clue. You try to read about all sorts of weird and scary diseases that might be it. It can become very consuming if you let it. I had to make a conscious effort to not read about it on the internet, to not talk/think about it all of the time, etc. I don't mean that the illness itself is "all in your head" or anything... just that you can magnify the sufferring it causes and the amount that it disrupts your life.

Anyway, I'm sorry that you are having such a hard time. Hope you get some answers, or at least some symptom relief, soon...

-Kira

PS- It might be worth it to start a new thread about this so that more people see it and can respond.

[Mark N]

I am sorry to hear of your situation. I am fortunate that when my spine was causing so many neurological problems it only took me three tries to find the OSS that knew how to fix my spine. On the other hand, without severe neurological impairments I won't do surgery and my OSS wouldn't do it if I wanted so I am let with pain meds. I have the good luck to have a PCP that deal with all of my meds and knows what he is doing. I have had my OSS and a gastro-intestinal doctor prescribe me meds but I have the PCP run them all so I only have one source to deal with. My biggest fear is moving or losing my doctors. When we did move to southern Indiana I have maintained my PCP in Indy.

I hope you find the right combination of doctors for you soon and your is controlled.

[anthoney]

I am sorry for anyone who suffers from chronic pain, but if a few more people like the Steve's or ChiroGeek, we might get something done. I AM VERY GREATFUL FOR THE TIME THEY SPEND DOING THIS!! I would say it needs to be a few Congress men or Senators but some how I see their Pages or House Keepers getting their daily "vitamins” .


Anthoney
Cervical Herniation c4 1991
L5/S1 Herniation 1999
L5/S1 discectomy 2001
New pain began radiating down right leg.
New Mri showed Bulge at L3 and Herniation at L4
Underwent 2 sets of RAC treatments.
2002 found tear in Labrum of hip. Insurance won't pay because of a high level of arthritis makes reoccurrence likely.
2004 Full Mri of spine found DDD in lower and upper lumbar and lower Thoracic and the need for a 3 level cervical spine fusion (c4,c5,c6) and a lumbar one (l4,l5 and I think s1)